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The problem is that they may be on the bridge already. Society tolerates tomboys far longer than sissies, a fact that can delay recognition of the underlying difficulties facing potential FTMs whose transgenderism persists as puberty approaches. At that point the cover offered to the world and to the child by jeans or short hair or baseball caps suddenly stops working.

For Isaac, whose parents agreed that he could use his real first name for this article, the crisis came as no surprise. Highly self-aware, articulate, and (thanks to the Internet) better informed than his parents, he’d for years been a passionate advocate for his own view of gender roles. “Around 6, I just started getting pissed at girls who wore pink,” he says. “Why are you doing that to yourself?”

Even though Isaac (then known by a girl’s name he prefers not to discuss) expressed a wish to grow a beard at age 10 and to dress as Jughead or a bloody corpse at Halloween, his parents, both downtown artists, thought their child was just “gender­queer,” and were proud of it. It wasn’t until camp the summer after sixth grade that they realized how fast things were moving: They dropped off a daughter at the beginning of the session and picked up a son at the end. In fact, the transition happened on day one. “I’d been to the same school since I was 2 and never had a blank slate,” Isaac says, and even though his mom and therapist advised that he wait until fall to make any changes, “I couldn’t stop myself.” He introduced himself as a boy, wore only the boxy boys’ clothing he’d brought, and swam in boys’ trunks in the lake. (Most of the girls in Isaac’s cabin accepted him as such—it was, after all, a performing-arts camp.) He was delighted, but his parents were stunned: Their daughter had disappeared.

But that’s not how Isaac saw it. That same year, he posted a video online ­consisting of stills of himself as a long-haired redhead in cute dresses gradually giving way to a crop-mopped urchin in a Brooks Brothers suit. The video, set to mournful alt-rock music, is called “There Once Was a Little Girl (Who Never Existed).”

Having forced the social transition at camp, Isaac insisted on returning to his Manhattan ­private school that fall as a boy. The school, blindsided, did not respond well. Isaac was made to sit in front of his seventh-grade class and explain himself to his peers, without any adult backup, feeling like he could not refuse to answer their intimate questions. (When asked “How do you hide your boobs?” he pulled an Ace bandage from his backpack and said, “I use this to bind my chest.”) He lost all his friends. “There was not one phone call for any birthday party or playdate for two years,” says his mother. Still, Isaac persisted, putting up with teachers’ insistence on grouping him with girls and petitioning the administration to be allowed to make a presentation to the school on November 20, the Transgender Day of Remembrance. (He was turned down.) “In the end, it was good for me to deal with that,” he says. “It was a hump to get over to express my gender in the way I wanted to.”

Persistence is a crucial feature of the transgenderism diagnosis, and a procedural quandary as well. One of the reasons many parents reject the idea of puberty blockers is that the evidence of persistence is equivocal. Some studies report that less than a quarter of prepubertal children diagnosed with gender dysphoria become transgender adults, but these numbers count anyone who leaves the study or does not elect to have surgery as nonpersistent. Even so, for many parents, the odds of their child continuing to identify as transgender are too low to justify a medical intervention, though of course a child is not an average of other children, and the point of the hormones is to buy time to sort things out. For kids like Isaac, whose transgender consciousness began early on and only intensified in adolescence, there may not be much to sort. They rarely revert.

Isaac’s parents certainly understood that he wasn’t kidding: “Who would stick with this transition in the face of such social pain if it weren’t true?” his mother says. But the puberty blockers he soon began campaigning for freaked her out. “I instinctually didn’t want to start messing with Isaac’s endocrine system. I said no.” As she recalls this, she looks tortured with guilt.

Despite Isaac’s pleas and arguments, supported by the advice of “every medical and psychiatric professional” his parents took him to see that fall, they waited. “It didn’t make sense to me,” he says. Tension in the family rose. By spring, when he was turning 13, and well past Tanner Stage 2, Isaac was terrified of the “super-feminine puberty horrors” that might start at any moment: “the period, of course, and the breasts. I was a ticking clock.”